BOWMAN, N.D. — Independent rural hospitals are increasingly forming collaborative groups to share resources and combine bargaining power with the goal of saving money and improving patient care.

The networks, which have cropped up in several states in recent years, offer small-town hospitals an alternative to selling to large hospital systems and forfeiting local autonomy.

“We found that we could both have the power of negotiation as a larger entity but also be able to negotiate lower costs for services and equipment,” said Dennis Goebel, CEO of Southwest Healthcare Services, a Bowman hospital that is part of the 22-member Rough Rider Network in North Dakota.

Since 2010, 153 rural hospitals in the U.S. have either shuttered completely or cut inpatient services, according to the Sheps Ce

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